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The ‘men’ in mental health: “We need to talk and make fewer judgements”

Medical cannabis patient, Jack Pierce, mental health support and what needs to change for men

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In the third of our Men’s Mental Health series, medical cannabis patient, Jack Pierce, who has a diagnosis of ADHD, autism and anxiety, speaks about mental health, cannabis and why there needs to be less judgement for men.

Read the first and second of our men and mental health series here.

It’s always difficult to know exactly how bad the problem with mental health actually is, as a lot of the cases go undiagnosed and  unreported. This is especially true for men, who often find it difficult to talk about mental health.

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Mental health access

Men are less likely to access psychological therapies than women, according to The Mental Health Foundation. Only 36 per cent of referrals to the NHS talking therapies are men. As a result, men may resort to other more dangerous ways of coping with mental health strain, such as drinking, drugs or violence. Men also have higher rates of homeless and are nearly three times as likely as women to become dependent on alcohol.

There are many reasons why men may choose to stay quiet when it comes to accessing help. In this series, the same themes were raised repeatedly as men reported feeling pressure to be dependable and to be seen as strong. Many also felt that there was little or no help from support services, community groups or even discussion among other men or male patients. This often left them feeling alone, vulnerable and in some cases, at risk.

This silence can be deadly. The Mental Health Foundation reported that in 2018, there were 6,507 suicides of which men accounted for three-quarters of that figure. This has remained relatively unchanged since the mid-90s.

Another issue when it comes to treating mental health is comorbidity, especially when it comes to neurological conditions.

Depression is more than two times higher in those with Attention Deficit Hyperactive Disorder (ADHD). And those on the autistic spectrum will find that they have higher levels of anxiety than neurotypical people.

One in five people are considered neurodiverse with a condition such as autism, ADHD, Tourettes, dyslexia, dyspraxia or obsessive-compulsive disorder.

Jack was diagnosed with chronic anxiety and depression as a teenager before his doctors reassessed him for autism and ADHD.

“I found out that my chronic anxiety and depression was actually ADHD and autism, so I got a diagnosis of both with combination ADHD. Everything changed but the depression and anxiety stayed,” said Jack.

“I tried cannabis recreationally and it helped me. I started on the legacy market before moving into the legal market. It’s difficult because I think a lot of the time, my ADHD and anxiety were masked by cannabis.

“When I got older, it became [more] difficult to mask, it’s impossible as a brain can’t mask for that many years.”

Masking can refer to two different things when it comes to ADHD or autism. Cannabis may offer relief from the constant, intense thought process of ADHD, helping to soothe or mask symptoms. It may also offer relief for those with autism.

Masking can also mean the practice of hiding ADHD or autistic traits to fit in with the neurotypical world. It can be exhausting and also traumatic for patients to do, as it takes more energy to monitor their behaviour. It can also be subconscious as patients learn to mimic the behaviour of others and get into patterns or routines based on what they have learned.

Mental health: A portrait photo of Jack Pierce

Jack Pierce

Mental health medication

When Jack started university, his supervisors began to notice different traits, along with his exceptional grades.

“People at university started to notice different things about me,” he said.

“I went from high school straight to university and got firsts which people don’t normally do. They thought there was something different about me and wanted to look into it.”

He added: “A lot of it was pushed on anxiety and anti-depressants. I took a lot of different medication to try to solve that which didn’t go well at all and it affected the diagnosis of ADHD.”

Jack was given different medications to try which had various side effects. It can be a difficult balancing act to prescribe the right medication for ADHD when a person also has depression and anxiety or autism.

Different symptoms from various conditions can make it a balancing act to find the correct mix for each individual person. Prescription drugs can encourage a variety of dangerous or unpleasant side effects in the meantime.

Jack stressed that while he needed medication, the tablets he was prescribed made him feel ill.

“For my anxiety, I was given propranolol and then was taken off that within three days of being prescribed because I get bad heart palpitations and arrhythmia issues. It felt as if my heart was going to explode, it was causing too much pressure,” said Jack.

“I was prescribed SSR inhibitors such as sertraline and citalopram. All of those made me withdrawn, gave me night terrors and sweats. I couldn’t function and would get really upset. I wouldn’t be able to live but then without them, I would get really unwell from depression. There were some moments of complete fallout and burnout where I was lost and I needed medication.”

Jack’s night terrors that felt so real he would wake up feeling emotional and stressed.

“I would wake up in puddles of sweat, quite emotional and stressed,” he said.

“I was given hydro-paroxetine to help me get some sleep which is quite an addictive drug to be prescribed. I didn’t want to take it because I would sleep and wake up feeling like I had missed a million hours. I couldn’t function. My autism and ADHD mean sleep medication is not a good thing to be consuming because it slows me down.”

Mental health and ADHD

Jack is now prescribed Elevanse and medical cannabis.

Elevanse is a stimulant drug often prescribed to treat ADHD in the UK. The capsules work on the parts of the brain that govern self-control and attention while helping to regulate them.  It is thought to reduce impulsive behaviour while increasing attention and concentration which ADHD patients can struggle with. Side effects can include headaches, weight loss, dry mouth, dizziness and feeling sick.

Jack decided to access a medical cannabis prescription to help with his mental health and after he became frustrated with the legacy market.

“When you are a patient using a legacy market, you are not prioritised or cared for,” he said.

“If you wake up one morning needing your medication, it may not be there and then accessing it is not always the easiest as you have to rely on other people to get it. Your mental health starts to fall because you aren’t getting treatment and having to go through that process is anxiety-inducing. I needed this plant to function.”

Jack continued: “I found out I could get a legal prescription through forums and decided to go for it. I reached out to try and improve my mental health. If I had been aware of the legal market before then I would have been able to get prescribed oils and would have been able to take a different approach, which may have improved my mental health and improved my disability.”

Medical cannabis is the last resort for a lot of patients due to the lack of education, stigma and reluctance of healthcare professionals to prescribe it. While cannabis has gained more media attention for conditions such as epilepsy or chronic pain, it is still not as well known for conditions such as ADHD or anxiety. A lot of patients find out about prescriptions by chance, the internet or family and friends, rather than healthcare workers.

University support

Universities in general are unsure how to deal with the issue of cannabis patients, as blanket drug bans mean there are usually no provisions for legal prescription holders. It’s yet another area where more cannabis education is badly needed.

Jack highlighted that there are students who are less inclined to speak publicly about medical cannabis in university. There are also many students who may risk being taken advantage of and wasting their student finance on cannabis through illegal markets.

“My university is not very supportive as I’m the first patient they have ever encountered,” he said.

“They don’t know how to advise me on taking my medication on campus, they don’t want me setting up societies because it’s advertising what is seen as illicit products. It’s still early days though and hopefully, with more conversations, we will get there.”

The figures for depression and anxiety amongst university students is also high, especially post lockdown. The Office of National Statistics estimates that one-third of students who started university in autumn 2021 are suffering from depression with 39 per cent showing symptoms of anxiety.

When it comes to mental health though, Jack said the university is incredibly supportive.

“It’s amazing. They run CBT therapy, psychologists and taught sessions. I have a weekly session with an advisor who I can talk to about anything. They write up notifications that say I can’t be spoken to off-guard in case I stutter or get nervous. That I might leave lectures at times due to stress. They make it a nice open communication with the whole university that I don’t have to partake in as they do it all,” he said.

“It’s nice to have that support daily and feel that I can go there, especially as a male. It’s difficult to say when we struggle and that I need help right now. I’ve never felt I can’t go to the mental health team at university and ask for help. That’s a credit to them.”

Creating change

So, where does Jack think the difficulties for men disclosing mental health struggles come from?

“I think it’s a fear of being judged. The anxiety of worrying if people still view me the same,” he said.

“I’m the only male in my family, so if I get upset, it’s like I’m the oldest son who shouldn’t be crumbling. But I do and it happens. A lot of us hide it and try to put a brave face on, mask it and keep going. At times it becomes really impossible.”

Male environments and friend groups may also make it difficult, as Jack explained: “When we are in environments around males they can just say ‘get over it’. They don’t get it and think it’s just a bad night but there are times I’ve been really upset. It’s not open for us to speak out about things. It can become really difficult and overwhelming for us.”

While there is a general acceptance and understanding that change needs to happen when it comes to encouraging men to speak out about mental health, there also needs to be spaces where they feel safe to do so. It can feel that change is coming but it is a slow process.

“We live in a really difficult time. If we could drop some judgement and understand that we are all human, if that could be shown towards men then maybe we will start to open up, share our lowest moments and know it’s okay to be upset,” said Jack.

“A lot of men worry that they may lose everything they have worked for. We need to educate men that if we go through these processes, we are still the same person that we were a few weeks ago.”

He added: “I’m not great sometimes but I’m still better for knowing this than hiding it away and pretending it’s all okay. We need to just talk and make fewer judgements.”

You can read last week’s article on men and mental health here

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Mental health

New data supports use of medical cannabis for anxiety and depression 

The study is thought to be the largest to date examining medical cannabis for anxiety and depression

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New data supports use of medical cannabis for anxiety and depression 
The symptom improvements seen were sustained for at least one year.

A Canadian survey has found evidence to suggest that medical cannabis is associated with sustained improvements in anxiety and depression.

In what is thought to be the largest dataset of its kind, Canadian researchers surveyed over 7,000 patients authorised to access medical cannabis products.

According to their findings, published in the journal Psychiatry Research, patients with symptoms of anxiety and/or depression report sustained improvements following the use of cannabis.

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Authors reported “statistically significant improvements” between subjects’ baseline and follow up scores on validated measurements of anxiety and depression. 

Greater improvements were seen in patients who were actively seeking medical cannabis to treat these particular conditions. 

Furthermore, according to the study, the symptom improvements seen were sustained for at least one year.

Building the evidence

The survey is thought to be the largest to date, exploring the effects of medicinal cannabis on anxiety and depression.

Findings from the UK also indicate that patients are finding it helpful for symptoms of these conditions.

The UK Patient Registry, which now includes data from around 2,000 patients, showed statistically significant improvements in anxiety, pain and sleep quality scores following treatment with medical cannabis.

Meanwhile data from the observational study, Project Twenty21, shows cannabis may be more effective at improving mood during the first three months of treatment, than some commonly prescribed antidepressants.

The authors concluded: “To our knowledge, this study is the largest completed to date examining the impact of medical cannabis use on anxiety and depression outcomes utilising longitudinal data and validated questionnaires.

“It provides evidence on the effectiveness of medical cannabis as a treatment for anxiety and depression that otherwise is not currently available, demonstrating that patients who seek treatment with medical cannabis for anxiety and depression can experience clinically significant improvements.”

They added: “This study offers reasonable justification for the completion of large clinical trials to further the understanding of medical cannabis as a treatment for anxiety and depression.”

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The most common reasons Australians are being prescribed medical cannabis

Medical cannabis has been prescribed over 140 conditions since 2016

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The most common reasons cannabis is being prescribed in Australia
248,000 prescriptions have been approved for Australians since 2016

New data from Australia, shows cannabis has been prescribed over 140 conditions since 2016, with anxiety among the most common.

The first in-depth study of Australia’s medicinal cannabis programme, shows the treatment has been prescribed for over 140 different conditions since it began in 2016. 

In total, 248,000 prescriptions have been approved for Australians since the inception of the scheme. 

Researchers at the University of Sydney’s Lambert Initiative for Cannabinoid Therapeutics, analysed data from the Therapeutic Goods Association’s (TGA) medical cannabis dataset  – Australia’s Special Access Scheme B – which is the only one of its kind in the world. 

No other country has monitored prescriptions in this way since launching their own medical cannabis programmes.

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The study found anxiety was among the top three reasons for patients being prescribed cannabis, the other two being pain and sleep disorders.

This reflects similar patterns in the UK, where chronic pain and anxiety are the most frequently prescribed for conditions, according to data from Project Twenty21. 

The team also found that the number of medicinal cannabis prescriptions have increased significantly since 2020 – over 85 percent of total prescriptions to date have been given since January 2020. They are currently unable to say whether the rise was pandemic related.

Lack of clinical evidence 

However, the researchers have warned that there is a limited number of high-quality clinical trials investigating the drug’s efficacy for these conditions.

Senior author Dr Elizabeth Cairns said the current evidence base for medicinal cannabis for anxiety is limited to only a few studies investigating CBD-dominant products, rather than THC-containing products

“Historically, the effects of THC have been described as anxiety-inducing, although this may depend on dose size and other factors.”

The evidence of effectiveness for medicinal cannabis in the treatment of pain is controversial, at least in Australia, where the Australian Faculty of Pain Medicine suggests not to prescribe medicinal cannabis for this purpose. Very few studies have also been done examining cannabis for the treatment of sleep disorders.

Study co-author and medicinal cannabis prescriber in her capacity as a GP, Associate Professor Vicki Kotsirilos AM from Western Sydney University, says the top reasons for prescriptions didn’t surprise her.

“Pain, anxiety and sleep issues are often interconnected – chronic pain can also cause mental health and sleep issues,” she says. 

Associate Professor Kotsirilos, who prescribes medical cannabis for pain, says this should only be done as a last resort, after more evidence based behavioural and drug therapies, such as counselling, exercise and deep breathing for pain, anxiety and/or sleep disorders, have failed or are of limited clinical benefit. 

Other interesting findings

The size of the dataset allowed the researchers to find prescribing patterns in small, but significant, populations that otherwise might have been overlooked.

“Apart from the link between anxiety and flower products, we found other interesting associations, for example, prescriptions of topical CBD for convulsions,” Dr Cairns said.

“This usage has not been extensively explored.”

The authors note, however, that the data doesn’t include patient outcomes.

Dr Cairns said: “Unfortunately, we just don’t know if these treatments were effective for these patients, but this data highlights where we can focus our attention next – to do focused studies and/or clinical trials.”

“There is a clear, unmet need for effective drug treatments across a variety of conditions that may be being helped with medicinal cannabis. For example, it could be worth conducting high-quality clinical trials on the use of flower products for anxiety, and that is certainly something that the Lambert Initiative and its collaborators may look to do in future.”

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Medical cannabis and neurodivergence – “It helps me tune in to sensory experiences”

Justin Clarke shares how cannabis has helped him find the freedom to enjoy life.

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Medical cannabis and neurodivergence - "It helps tune in to sensory experiences"
Justin says cannabis helps him enjoy sensory experiences such as eating or listening to music.

My quality of life has improved significantly since starting to use medical cannabis, writes Justin Clarke, who is neurodivergent, in that he is autistic and has ADHD.

I consider both my being autistic and ADHD to be linked – this is because both significantly impact my sensory processing. I consider them to be ways to describe differences in the way my mind works to the perceived norm. 

I suffer in terms of mental health from anxiety and depression and I am working through complex trauma in therapy. I attribute many of my mental health struggles to the challenges of living as a neurodivergent person in a world that is frequently invalidating and rarely tries to understand or accommodate without a fight.

I’m now 33, and was officially diagnosed as autistic during my last semester at university at the age of 22, and as being ADHD (Combined Type) just two years ago.

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Autism is a lifelong neurodevelopmental difference, which affects how people communicate and interact, as well as emotional and sensory processing – amongst many other things. 

Autism tends to be described as being like a spectrum and it can affect people in many different ways. I view it as a spectrum of varying colours and shades, with a lot of complexity to it, rather than as a straight line that goes from ‘mild’ to ‘severe’. Things aren’t that simple at all.

Functioning labels such as ‘high functioning’ and ‘low functioning’ are losing favour in recent times, as we begin to recognise and accept that one’s level of “functioning” is not static and can vary significantly from day to day depending on how it is defined and by whom.

I describe the sensory overwhelm I often experience as being like having all of my senses with the sliders turned up on a figurative stereo equaliser, with no ability to turn them down. 

Cannabis makes them easier to control and process.

Meanwhile, ADHD is a neurodivergence that can involve impulsive behaviours and unusual levels of hyperactivity as well as difficulties with motivation and attention span. 

As with autism it is usually diagnosed in childhood and the way it affects people can vary significantly. There are commonly described to be three types; ‘Inattentive’, and ‘Impulsive’, and ‘Combined’.

Justin Clarke, 33.

Discovering cannabis

I was first prescribed medical cannabis for anxiety following the establishment of Project Twenty21 by Drug Science in 2020. 

Anxiety has been a frequent visitor and presenter of challenges to me as a neurodivergent person living in a world designed for the fabled ‘default human’ or neurotypical. 

Sensory and social anxiety are the main forms of anxiety that I find cannabis to be helpful for – the way it helps with these mainly is by allowing me to better filter and modulate my senses.

I am more socially relaxed and can better participate in conversation when I am not experiencing sensory overwhelm. I don’t get overloaded so quickly by lots of sensory info of different kinds coming in at once.

I can better ‘tune in’ to sensory experiences such as eating food and listening to music. I can enjoy these things without cannabis but it helps me to better immerse myself in them and the experience.

With my sensory processing figuratively eased by cannabis, I also find that executive functioning-related challenges such as staying focused and motivated on tasks to become more achievable.

Social situations

My quality of life has improved significantly since starting to use medical cannabis.

Another thing I find cannabis helpful for is social situations and being around people like in crowded places such as music gigs. This again is mainly because of how it enables me to better tolerate sensory discomfort and anxiety. With it’s help I am able to feel more relaxed in crowds and in unfamiliar social situations.

I am also working through some emotional trauma in therapy and have found cannabis to be helpful in enabling me to talk more openly, as well alleviating some of the trauma-related anxiety that has sometimes resulted from my sessions.

A gentler medication 

From 2014 to 2018, I was prescribed sertraline, an antidepressant that belongs to a group of drugs called selective serotonin reuptake inhibitors. I would describe it as having been very emotionally numbing most of the time, although it was helpful in some ways.

Using cannabis for my anxiety and depression has enabled far better quality of life compared with sertraline in hindsight. It has especially been helpful in topically alleviating anhedonia – the loss of the ability to enjoy things.

I’ve also taken prescribed amphetamines to cope with ADHD which have been useful at times depending on the situation, but they kill my appetite and disturb my sleep, so I tend to use cannabis alongside them to calm down and stimulate my appetite.

Both help my concentration and motivation in different ways, however cannabis is far gentler.

Amphetamines are like an on switch, whereas cannabis gives me the freedom to choose to tune in to what I’m doing and often tends to induce a state of calm inquisitiveness in me.

More often than not, I’ve been able to entirely replace my use of amphetamines with medical cannabis. Unfortunately with it only available privately it is significantly more expensive which means replacing the NHS-prescribed stimulants with them entirely isn’t yet really an option.

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